Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI).
- On the ABN form, it has a place to enter information to contact the Medicare contractor. What information is put here and how do I find this information?
- If in 90 days you have not gotten a decision on your claim, contact the Medicare contractor
or at: Telephone: TTY/TDD:
The Medicare contractor is the Medicare Administrative Contractor (MAC).
A Medicare Administrative Contractor (MAC) is a private health care insurer that is awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
The MAC is specific to your region/jurisdiction. Your biller will have the contact information for your MAC. The map below shows the various MACs and their area of coverage.
- Did CMS issue a ruling not to use the NOMNC forms for non-traditional Medicare? Please clarify.
The rules for the NOMNC and SNF ABN differ:
- Many Managed Medicare providers will provide their NOMNC with their specific contact information. The facility may use the generic form in the absence of the Managed provider.
- The NOMNC is required for all Medicare A/B and Managed A/B patients to inform and provide an avenue for an expedited appeal.
- However, the SNF ABN is only used for traditional fee for service Medicare Part A beneficiaries.